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CMS proposed to update hospital outpatient prospective payment system (OPPS) rates by 1.55% in the calendar year 2017 compared to CY 2016, according to the American Hospital Association (AHA).
The rule also proposes to implement the site-neutral provisions of Section 603 of the Bipartisan Budget Act of 2015, which requires that, with the exception of dedicated ED services, services furnished in off-campus provider-based departments (PBDs) that began billing under the OPPS on or after Nov. 2, 2015, would no longer be paid under the OPPS. Instead, these services would be paid under other applicable Part B payment systems beginning Jan. 1.
CMS proposes that, in 2017, the physician fee schedule (PFS) would be the payment system for the site-neutral rates for most services furnished in a new off-campus PBD, according to the AHA. Specifically, CMS would pay physicians furnishing services in these departments at the higher “nonfacility” PFS rate. “There would be no payment made directly to the hospital by Medicare,” the AHA said.
Existing off-campus PBDs that expand their services to include those in new clinical families would receive the site-neutral rate for those services, the AHA said. Also, any existing off-campus PBD that relocates after Nov. 2 would lose its excepted status and be subject to site-neutral payments. “An existing off-campus PBD that undergoes a change of ownership would only maintain its excepted status if the new owner accepts the existing Medicare provider agreement from the prior owner,” the AHA said.
AHA Executive Vice President Tom Nickels said the association is “extremely dismayed by the short-sighted policies” in the proposed rule. “Taken together, it appears that CMS is aiming to freeze the progress of hospital-based health care in its tracks,” Nickels said. “We will submit detailed comments to the agency urging them to revise these misguided policies so that hospitals can continue to provide the highest quality health care to their communities.”
The proposed rule can be accessed at http://bit.ly/29NT4Em.
Executive Editor Joy Dickinson, Nurse Planner Kay Ball, Physician Reviewer Steven A. Gunderson, DO, and Consulting Editor Mark Mayo report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Stephen W. Earnhart discloses that he is a stockholder and on the board for One Medical Passport.